BACKGROUND: Chronic pain places a major clinical and economic burden on the United States, impacting greater than 30% of the population with an estimated cost of $560-$635 billion per year. Furthermore, patients with poorly managed chronic pain account for a disproportionate share of emergency department (ED) visits. To the best of our knowledge, information on insurance status by payor type is not available on patients who present to the ED with a chief complaint of pain. Acquisition of this knowledge would be critical for development of care plans designed to improve patient satisfaction and reduce utilization of acute care services. In this abstract, we evaluated the insurance status of patients presenting to the ED with a chief complaint of pain in an effort to subgroup this cohort by payor type.

METHODS: After obtaining IRB approval, a retrospective cross-sectional analysis was conducted to identify patients who had at least 1 ED visit at Duke University Hospital (DUH) between 6/1/14-12/1/14. Insurance information was collected for each patient encounter. The resulting data set was then transferred to Microsoft Excel, where pivot tables were used to summarize the data into subgroups. Tableau was then used to graphically illustrate these data and evaluate data trends.

RESULTS: 6,376 patients with a total of 7,669 pain-related ED encounters were identified during the study period. Five (5) payor groups were isolated (commercial, Medicaid, Medicare, Medicare Advantage and self pay). A sixth group was identified where insurance information was not available. Figure I illustrates the study population by payor type. Four (4) DRGs accounted for the majority of ED visits: abdominal pain, chest pain, back pain and lower extremity pain. Abdominal pain, chest pain and lower extremity pain were the top three DRGs for patients that were insured commercially, by Medicare, Medicaid or Medicare Advantage and for patient encounters where data was not available. The top three DRGs for self pay patients were abdominal pain, chest pain and back pain (Figure II). When a subgroup analysis was performed, Medicare, Medicaid and Medicare advantage patients accounted for 60.8% of sickle cell pain crisis ED encounters (Figure III).

DISCUSSION: This analysis revealed that insurance status is not evenly distributed by payor type for patients presenting to the ED for management of pain at DUH. Furthermore, the study suggested that the three most common DRGs may change by payor type and that sickle cell patients presenting for management of acute pain crisis are most often covered by Medicare, Medicaid and Medicare Advantage. One limitation of this study is that payor data was not available for roughly 20% of patient encounters, across both the primary and subgroup analyses.

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